MAY 19, 2022 | COMMUNICATION BULLETIN 2021-22 ISSUE 61 IN THIS ISSUE: Provider Touchpoint | Clarification from Q&A Webinar for Vaya Providers | Corrections to COVID-19 Rate Extensions to June 30, 2022 | Appendix K Flexibilities Extended | IRIS Downtime | Provider Enrollment Form (SurveyMonkey Apply) Downtime | Mental Health Awareness Month: Mental Health Awareness Series
Provider Touchpoint Friday, May 20, 2022, 11 a.m.-12 p.m. Our biweekly Q&A Webinar for Vaya Health Network Providers has a new name: Provider Touchpoint.
A touchpoint is defined as a point of contact or interaction, especially between a business organization and its customers or consumers. The contact may occur in person, through a website, an app, or any other form of communication. Vaya’s Provider Touchpoint is your source for the latest information on topics that affect Vaya network providers. We encourage all network providers to attend. Registration is not required. The link to each webinar is published both the week prior to and the week of the event in the Provider Communication Bulletin.
PROVIDER TOUCHPOINT – MAY 20, 2022
Clarification from Q&A Webinar for Vaya Providers To clarify information from Vaya during the May 6, 2022, Q&A Webinar for Vaya Providers, please note that outpatient therapy (OPT) providers must obtain prior authorization of a service authorization request (SAR) from Vaya Utilization Management prior to billing for OPT services delivered to a member during the same authorization period as an enhanced or residential service. For more information, please review the memo “Authorization for Medicaid-Funded Outpatient Therapy Services,” published May 5, 2022, in Provider Communication Bulletin Issue 59.
COVID-19 NEWS AND UPDATES
Corrections to COVID-19 Rate Extensions to June 30, 2022 Vaya has updated all reimbursement rates in AlphaMCS to reflect the following COVID-19/PHE supplements for the Medicaid(b)/(b)(3)and Medicaid(c) benefit plans to June 30, 2022: PRTF and Residential Services under the Targeted Enhanced Rates: 15% ICF/IID Services: 15% Mobile Crisis and Crisis Stabilization Services: 5% Outpatient and E&M Services by MD, PA, and NP Licensed Providers: 5% Community-Based Services, including Community Networking and Community Living and Support: 15% Supported Employment: 20% Assertive Community Treatment (ACT) Team, Respite (Individual), Supported Living, and related services: 50% SA Outpatient and SA Community Residential Services: 5% Vaya initially corrected rates in late April and, as recently as this week, confirmed and identified additional rates corrections to ensure rates in AlphaMCS match the posted standard rate schedules. Due to rate changes taking effect retroactively to April 1, 2022, Vaya will readjudicate all provider claims that were processed and paid at a lower rate than the rate schedule due to the delay in entry of corrected rates. We expect the readjudication to occur on or about May 21, 2022. Claims payments for retroactive adjustments will be reflected in remittance advices (RAs) beginning May 31, 2022. Providers are encouraged to refer to the updated Medicaid Benefit Plan Rate Schedules to confirm the rate supplement for each eligible service code. Modifiers to service codes, including the GT, CR and GTCR combinations, are not specifically listed in the tables but will remain valid in effect through June 30, 2022. Services with these modifiers reimburse at the same rate as the base code and will now include the COVID-19/PHE Rate Supplement through June 30, 2022. Please remember to make necessary changes to billing systems, including in the HHA system for all Electronic Visit Verification (EVV) services and to bill charges at or above the posted rates to receive the full unit reimbursement. Claims reprocessing will not impact any claims for which the provider has filed charges that are less than the rates indicated in the applicable rate schedule. Providers are responsible for filing replacement claims to include a charge that will earn the full reimbursement rate. Please contact your Claims Specialist for assistance with previously filed claims. For more information on Vaya services and reimbursement rates, email provider.info@vayahealth.com.
Appendix K Flexibilities Extended On April 6, 2020, the Federal Centers for Medicare & Medicaid Services (CMS) approved the initial Appendix K Emergency Preparedness and Response Waiver Request submitted by NCDHHS in response to the COVID-19 State of Emergency. Appendix K allows specific flexibilities in how Medicaid beneficiaries receive home and community-based services through the Community Alternatives Programs for Children and Disabled Adults (CAP/C and CAP/DA) and the NC Innovations and Traumatic Brain Injury (TBI) waivers. Appendix K flexibilities for CAP/C, CAP/DA, and the Innovations and TBI waivers have been updated to include an anticipated end date of “through six months following the end of the Public Health Emergency”. As a result, the current Appendix K flexibilities will be extended from October 2022 to Jan. 16, 2023. This extension applies to all previously approved Appendix K flexibilities for CAP/C, CAP/DA, and the Innovations and TBI waivers. Extended flexibilities will require submission of the updated COVID-19 Appendix K Reporting Form.
To report the use of a new flexibility or an extension of a previously reported one, complete the Appendix K Reporting Form available on Vaya's COVID-19 Provider Information webpage. To receive a copy of the submitted form, please remember to select the option to “Print or get PDF of answers” after submitting the form. The requested effective start date for Appendix K-related changes can be no earlier than 90 days before the request, and the requested effective end date for changes can be no later than Jan. 16, 2023. Please note: Innovations Waiver participants under age 22 are subject to limits on sets of services during the school year. Under Appendix K, Respite is the only service allowed during the school day, with specific parameters around its use. Please review NCDHHS Joint Communication Bulletin #J375 for details.
IRIS Downtime The NC Division of MHDDSAS and the NC Department of Information Technology will update the state’s Incident Response Improvement System (IRIS) on Wednesday, May 25, 2022. IRIS will be unavailable for all users from 7 a.m. to approximately 8 a.m. on Wednesday, May 25. Because IRIS reports are due within 72 hours from the time the provider learns of an incident, we encourage providers to obtain a hard copy of the reporting form from the IRIS website before Wednesday morning or print forms from the NCDHHS website. Submit reports to Vaya by fax at 828398-4407 or by email IncidentReport@vayahealth.com, or to the Division of MHDDSAS Customer Service and Community Rights Team via fax at 919-733-4962 within the specified timeframes and procedures. Providers will still need to enter the report into IRIS once the system is available. Reports to be filed with the DHSR Healthcare Personnel Registry should be faxed within the specified timeframes to 919-733-3207. Reports regarding deaths (suicide, homicide/violence, accident, or restraint) in a licensed facility should be reported to the DHSR Complaint Intake Unit via fax at 919-715-7724.
Provider Enrollment Form (SurveyMonkey Apply) Downtime SurveyMonkey Apply, which hosts the online Vaya Provider Enrollment Form, will perform scheduled maintenance starting at 7 p.m. on June 1, 2022. During this time, providers will not be able to access to platform for up to three hours.
Mental Health Awareness Month: Mental Health Awareness Series In recognition of Mental Health Awareness Month in May, the Division of MH/DD/SAS is hosting a Mental Health Awareness series. This series will provide information on existing resources, promote mental health and wellbeing, and share best practices in care. The series offers weekly webinars throughout the month. View the series flyer for more information.
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